Multimodal osteopathic manipulative treatment is efficacious for chronic low back pain (LBP).1 However, systematic reviews have excluded osteopathic studies that have used multimodal treatments because they do not assess each technique individually.2-4 Researchers in Spain performed a double-blind randomized sham-controlled trial to evaluate the effects of using only myofascial release (MFR) therapy on pain level (using the Short Form McGill Pain Questionnaire [SF-MPQ] and Visual Analog Scale [VAS]), disability (using the Roland-Morris Questionnaire), and fear-avoidance beliefs (using the Fear-Avoidance Belief Questionnaire) in patients with chronic LBP.

Researchers recruited 54 adults (33 women, 21 men) aged 18 to 60 years with nonspecific chronic (>3 months) LBP. Exclusion criteria were pregnancy, spinal infection or tumors, systemic diseases, fibromyalgia, cauda equina syndrome, spine surgery, musculoskeletal injuries, previous MFR treatment, or rehabilitation treatment for back pain within the past 2 months. Although all participants could continue with their pharmaceutical therapies, no other information regarding these therapies was provided. Patients were randomly assigned to the MFR (n=27; mean [SD] age, 46.6 [10.3] years) or sham MFR (n=27; mean [SD] age, 46.4 [11.4] years) groups. The MFR group received four 40-minute sessions of MFR. Treatment consisted of (1) longitudinal sliding of the lumbar paravertebral muscles, (2) MFR of the thoracolumbar fascia, (3) quadratus lumborum MFR, and (4) MFR of the psoas muscle. The sham MFR was light touch applied during four 40-minute sessions. Because both interventions were applied by the same trained physical therapist, blinding of the operator was not possible.

The outcome measures were assessed before treatment (baseline), immediately after treatment (week 2), and at follow-up (week 12). Four participants from the MFR group and 2 from the sham MFR group were lost to follow-up at week 12. Intention-to-treat analysis was used, and 1 participant from each group was excluded from analysis because they had scored 0 at baseline in one of the variables.

These results suggest there is a short- and long-term decrease in pain level, disability, and fear-avoidance beliefs with MFR treatment for chronic LBP. The results, however, were not clinically significant, as the Minimal Clinically Important Difference parameters were not met for any of the outcome measures. Several other limitations exist. First, it was not clear if the baseline characteristics of the 2 groups were similar specifically for the baseline VAS and fear-avoidance scores. Second, the clinical significance of the outcome measures and the assessment tools was not discussed thoroughly. Third, no information regarding the participants’ employment status—and hence the relevance of the disability score—was provided. Fourth, the authors did not comment on how many patients were screened and why only 54 were recruited given that the initial power analysis required a sample size of 60 with an expected 10% dropout rate. Fifth, no information was provided regarding the reduction in pain and disability at week 2, though potential mechanisms for improvements were provided. Larger studies using better designs and comparative effectiveness trials using different modalities would help to discern which techniques provide the best outcomes in patients with chronic LBP.